Summary Combination of DSE OSCE Test Prep| 170
questions| with complete solution/explanations_ 2022.
What are the ADA recommendations for when pre-med is required Correct
Answer: - prosthetic cardiac valves, including transcatheter-implanted prostheses
and homografts
- prosthetic material used for cardiac valve repair, such as annuloplasty rings and
chords
- a history of infective endocarditis
- a cardiac transplanta with valve regurgitation due to a structurally abnormal valve
- the following congenital (present from birth) heart disease
--unrepaired cyanotic congenital heart disease, including palliative shunts and
conduits
--any repaired congenital heart defect with residual shunts or valvular regurgitation
at the site of or adjacent to the site of a prosthetic patch or a prosthetic device
**ADA website**
https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
41-yo woman, pregnant; prev rheumatic fever with heart murmur (no valvular
abnormality); allergy to penicillin. Positive history of infective endocarditis. Does
she need to pre med?
- yes
- no Correct Answer: yes
- REVIEW HEALTH HISTORY - on my exam, this patient had a previous history
of infective endocarditis. Pre-med IS indicated
- many of the OSCE quizlets say no....
Pre-med options for pregnant woman w/hx of infective endocarditis and penicillin
allergy
- amoxicillin
- cephalexin
- clarithromycin
- ciproflaxacin Correct Answer: *clarithromycin*
I may not be correct, the correct option may be cephalexin. however I chose
clarithromycin due to penicillin allergy, cross reaction with cephalosporins, and
since clindamycin/erythromycin/azthromycin were not options. Ciproflaxacin is
contraindicated in pregnancy. article for reference
https://www.parents.com/pregnancy/my-body/is-it-safe/antibiotics-and-pregnancy/
,What procedure can a dentist perform without consulting MD if a patient is
currently taking bisphosphonates?
- endo therapy
- prophy and scaling
- extraction
- occlusal restoration Correct Answer: *occlusal restoration*
although the main HELL NO is extraction, completing endo therapy increases risk
if the apex is compromised/damaged during therapy. I teetered on prophy and
scaling, but since it did not specify supragingival, decided that the risk of scaling
can negatively affect the periosteum of a bisphosphanate patient. ADA
recommendations:
http://www.centreoms.com/admin/storage/news/ADA%20Recommendations
%20for%20Treatment%20of%20Patients%20on%20Bisphosphon.pdf
Pregnant person afraid of needles - stress management by putting patient in what
position when in your chair (BEFORE they even get to the point of passing out)?
- supply oxygen
- place in Trendelenburg
- make patient sit up straight
- tell them to suck it up buttercup Correct Answer: place her in Trendelburg
position.
- supine hypotension in 3rd trimester usually occurs (bc compression Inf vena
cava) => must prevent this in dental chair bc it can cause patient to pass out.
- Best preventative treatment for supine hypotension is to turn the patient,
preferably to the left side, to displace the uterus away from the inferior vena cava.
The patient can also be placed in a sitting position with the knees flexed.
6 months pregnant had bleeding gums and mobile teeth, how should they be
treated?
- immediate extractions
- do not treat until baby is born
- conservative debridement
- immediate endo Correct Answer: conservative debridement
.- pregnancy gingivitis: important to do ScRP (and stress good oral hygiene) to
prevent plaque growth. The plaque can enter blood stream and stimulate patient's
immune system to produce prostaglandins, which can trigger uterine contraction
leading to early labor, premature birth, and a small baby.
Pregnant lady with a diastema in between #8 and #9 with deep probing depth and
class 1 mobility on 8 and 9. What is the reason for diastema?
,- chronic periodontitis
- distal drift
- normal during pregnancy Correct Answer: chronic perio
- increased incidence of periodontal disease during pregnancy => must emphasize
good oral hygiene, and remove all their plaque so it doesn't lead to premature
birth / low birth weight
Permanent staining as a result of tetracyline; did this happen?
- During development (as fetus)
- 0-5yrs
- 5-10 yrs
- 10-15 yrs Correct Answer: age 0-5 years
- remember that PERMANENT dentition does not begin calcification until birth
Pentobarbital (Nembutal) and Secobarbital (Seconal) are what type of drugs?
- benzodiazepines
- NSAIDS
- barbituates
- atypical antipsychotic Correct Answer: barbituates
- used primarily evening BEFORE appointment
A patient has an allergic reaction to a barbiturate, how do you treat?
- epinephrine
- diphenhydramine
- send to ER Correct Answer: benadryl (diphenhydramine)
- And discontinuation of the drug. Obviously if there are concerns with airway,
treatment may differ... but this was not indicated in the question stem. However, I
did not have answer choices that reflected this scenario nor was it addressed in the
question stem
A patient is on a steroidal medication. What information do you need to obtain
before treating them?
- dose and pharmacy that filled the RX
- duration of prescription
- both dose and duration Correct Answer: *dose and duration*
- "The rule of twos": Ask whether the patient is currently on steroids or has been
on corticosteroids for 2 weeks or longer within the past 2 years. You must go back
2 years in the history because it can take 2 weeks to 2 years for the adrenal glands
to bounce back to normal function.
, What is the most important factor when calculation medication dosage for a child
- age
- weight
- gender
- height Correct Answer: weight
A patient is confirmed to have trisomy 21. What are you initially concerned about?
- congenital heart defect
- Cushings
- cerebrovascular accident Correct Answer: congenital heart defects; however,
early onset periodontal disease is a significant oral health issue, but this was not an
answer for those who have had this question. Consider cardiac status and posibility
of pre-medication
- atrioventricular septal defect, patent ductus arteriosus, Tetralogy of Fallot
A patient has recently had a stroke. What is your first concern?
- when was their last cleaning
- are they on anticoagulants
- current blood pressure Correct Answer: Are they on anticoagulants
- Stroke patients could be on blood thinners, such as aspirin, dipyradamole
(Persan- tine), clopidogrol (Plavix), or Coumadin, postrecovery. Prior to major
surgery, always consult with the patient's physician to determine whether and when
the blood thinners can be stopped and subsequently restarted.- . Following a CVA
that required significant hospitalization, routine dental treatment must be delayed
by 6 months.- Routine dental treatment should be delayed by 3 months if the post-
CVA recovery was uneventful and the patient was admitted overnight just for
observation.- Avoid epinephrine containing LAs during the first 6 months of dental
treatment. Subsequent use of epinephrine depends on the patient's prognosis.
Epinephrine containing LAs can be used starting 1 year after the stroke, when the
patient demonstrates progressive improvement of the CVA and absence of TIAs.
What is the main symptom that differentiates anaphylaxis from syncope?
- bronchoconstriction
- clammy skin and pallor
- nausea, vomiting Correct Answer: Anaphylaxis is accompanied by wheezing,
bronchoconstriction
- anaphyalxis: intense itching, hives, flushing over the face and chest. Rhinitis,
conjunctivitis, nausea, vomiting, abdominal cramps, and perspiration. Palpitation,
tachycardia, sub- sternal tightness, coughing, wheezing, and dyspnea. BP drops
rapidly and loss of consciousness or cardiac arrest can occur in severe cases.-
questions| with complete solution/explanations_ 2022.
What are the ADA recommendations for when pre-med is required Correct
Answer: - prosthetic cardiac valves, including transcatheter-implanted prostheses
and homografts
- prosthetic material used for cardiac valve repair, such as annuloplasty rings and
chords
- a history of infective endocarditis
- a cardiac transplanta with valve regurgitation due to a structurally abnormal valve
- the following congenital (present from birth) heart disease
--unrepaired cyanotic congenital heart disease, including palliative shunts and
conduits
--any repaired congenital heart defect with residual shunts or valvular regurgitation
at the site of or adjacent to the site of a prosthetic patch or a prosthetic device
**ADA website**
https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
41-yo woman, pregnant; prev rheumatic fever with heart murmur (no valvular
abnormality); allergy to penicillin. Positive history of infective endocarditis. Does
she need to pre med?
- yes
- no Correct Answer: yes
- REVIEW HEALTH HISTORY - on my exam, this patient had a previous history
of infective endocarditis. Pre-med IS indicated
- many of the OSCE quizlets say no....
Pre-med options for pregnant woman w/hx of infective endocarditis and penicillin
allergy
- amoxicillin
- cephalexin
- clarithromycin
- ciproflaxacin Correct Answer: *clarithromycin*
I may not be correct, the correct option may be cephalexin. however I chose
clarithromycin due to penicillin allergy, cross reaction with cephalosporins, and
since clindamycin/erythromycin/azthromycin were not options. Ciproflaxacin is
contraindicated in pregnancy. article for reference
https://www.parents.com/pregnancy/my-body/is-it-safe/antibiotics-and-pregnancy/
,What procedure can a dentist perform without consulting MD if a patient is
currently taking bisphosphonates?
- endo therapy
- prophy and scaling
- extraction
- occlusal restoration Correct Answer: *occlusal restoration*
although the main HELL NO is extraction, completing endo therapy increases risk
if the apex is compromised/damaged during therapy. I teetered on prophy and
scaling, but since it did not specify supragingival, decided that the risk of scaling
can negatively affect the periosteum of a bisphosphanate patient. ADA
recommendations:
http://www.centreoms.com/admin/storage/news/ADA%20Recommendations
%20for%20Treatment%20of%20Patients%20on%20Bisphosphon.pdf
Pregnant person afraid of needles - stress management by putting patient in what
position when in your chair (BEFORE they even get to the point of passing out)?
- supply oxygen
- place in Trendelenburg
- make patient sit up straight
- tell them to suck it up buttercup Correct Answer: place her in Trendelburg
position.
- supine hypotension in 3rd trimester usually occurs (bc compression Inf vena
cava) => must prevent this in dental chair bc it can cause patient to pass out.
- Best preventative treatment for supine hypotension is to turn the patient,
preferably to the left side, to displace the uterus away from the inferior vena cava.
The patient can also be placed in a sitting position with the knees flexed.
6 months pregnant had bleeding gums and mobile teeth, how should they be
treated?
- immediate extractions
- do not treat until baby is born
- conservative debridement
- immediate endo Correct Answer: conservative debridement
.- pregnancy gingivitis: important to do ScRP (and stress good oral hygiene) to
prevent plaque growth. The plaque can enter blood stream and stimulate patient's
immune system to produce prostaglandins, which can trigger uterine contraction
leading to early labor, premature birth, and a small baby.
Pregnant lady with a diastema in between #8 and #9 with deep probing depth and
class 1 mobility on 8 and 9. What is the reason for diastema?
,- chronic periodontitis
- distal drift
- normal during pregnancy Correct Answer: chronic perio
- increased incidence of periodontal disease during pregnancy => must emphasize
good oral hygiene, and remove all their plaque so it doesn't lead to premature
birth / low birth weight
Permanent staining as a result of tetracyline; did this happen?
- During development (as fetus)
- 0-5yrs
- 5-10 yrs
- 10-15 yrs Correct Answer: age 0-5 years
- remember that PERMANENT dentition does not begin calcification until birth
Pentobarbital (Nembutal) and Secobarbital (Seconal) are what type of drugs?
- benzodiazepines
- NSAIDS
- barbituates
- atypical antipsychotic Correct Answer: barbituates
- used primarily evening BEFORE appointment
A patient has an allergic reaction to a barbiturate, how do you treat?
- epinephrine
- diphenhydramine
- send to ER Correct Answer: benadryl (diphenhydramine)
- And discontinuation of the drug. Obviously if there are concerns with airway,
treatment may differ... but this was not indicated in the question stem. However, I
did not have answer choices that reflected this scenario nor was it addressed in the
question stem
A patient is on a steroidal medication. What information do you need to obtain
before treating them?
- dose and pharmacy that filled the RX
- duration of prescription
- both dose and duration Correct Answer: *dose and duration*
- "The rule of twos": Ask whether the patient is currently on steroids or has been
on corticosteroids for 2 weeks or longer within the past 2 years. You must go back
2 years in the history because it can take 2 weeks to 2 years for the adrenal glands
to bounce back to normal function.
, What is the most important factor when calculation medication dosage for a child
- age
- weight
- gender
- height Correct Answer: weight
A patient is confirmed to have trisomy 21. What are you initially concerned about?
- congenital heart defect
- Cushings
- cerebrovascular accident Correct Answer: congenital heart defects; however,
early onset periodontal disease is a significant oral health issue, but this was not an
answer for those who have had this question. Consider cardiac status and posibility
of pre-medication
- atrioventricular septal defect, patent ductus arteriosus, Tetralogy of Fallot
A patient has recently had a stroke. What is your first concern?
- when was their last cleaning
- are they on anticoagulants
- current blood pressure Correct Answer: Are they on anticoagulants
- Stroke patients could be on blood thinners, such as aspirin, dipyradamole
(Persan- tine), clopidogrol (Plavix), or Coumadin, postrecovery. Prior to major
surgery, always consult with the patient's physician to determine whether and when
the blood thinners can be stopped and subsequently restarted.- . Following a CVA
that required significant hospitalization, routine dental treatment must be delayed
by 6 months.- Routine dental treatment should be delayed by 3 months if the post-
CVA recovery was uneventful and the patient was admitted overnight just for
observation.- Avoid epinephrine containing LAs during the first 6 months of dental
treatment. Subsequent use of epinephrine depends on the patient's prognosis.
Epinephrine containing LAs can be used starting 1 year after the stroke, when the
patient demonstrates progressive improvement of the CVA and absence of TIAs.
What is the main symptom that differentiates anaphylaxis from syncope?
- bronchoconstriction
- clammy skin and pallor
- nausea, vomiting Correct Answer: Anaphylaxis is accompanied by wheezing,
bronchoconstriction
- anaphyalxis: intense itching, hives, flushing over the face and chest. Rhinitis,
conjunctivitis, nausea, vomiting, abdominal cramps, and perspiration. Palpitation,
tachycardia, sub- sternal tightness, coughing, wheezing, and dyspnea. BP drops
rapidly and loss of consciousness or cardiac arrest can occur in severe cases.-
